Casey Crabtree is a Republican state senator from District 8, which covers Brookings, Kingsbury, Lake and Miner counties.

In 2022, South Dakota voters expanded Medicaid eligibility to adults with incomes up to 138% of the poverty level. The amendment was placed in the state’s Constitution and can only be changed by South Dakota voters. Since then, the legislature has dutifully implemented Medicaid expansion and more than 28,000 individuals are currently enrolled.

One of the key points by proponents of Medicaid expansion was that federal government pay 90% and South Dakota taxpayers pay the remaining 10%. Right now, that 10% is projected to cost South Dakota taxpayers about $20 million a year for the upcoming fiscal year.

Voters have concluded that improvements should be made to the language that was implemented in 2022. During the 2024 legislative session, Rep. Tony Venhuizen and I proposed a constitutional amendment that allowed the state of South Dakota to consider a work requirement for able-bodied adults aged 18-65 that enrolled in Medicaid expansion. The proposal gained the support of every Republican in the legislature, and the amendment went on to be the only ballot measure out of seven to pass on the November ballot.

The incoming Trump administration, the new Republican Congress, and the Elon Musk and Vivek Ramaswamy-led “DOGE” are all working to find ways to control federal spending. Regardless of your political affiliation, we can all see wasteful government spending at the federal level and should be glad to see real attention being paid to this issue. News out of Washington says one way the feds could reduce spending is by lowering the federal share of Medicaid expansion from 90% to between 70% and 80%. Each percentage in reduction would cost South Dakota taxpayers about $2 million.

In the upcoming session, Rep. Venhuizen and I will introduce another joint resolution proposing a constitutional amendment binding Medicaid expansion to the level of federal medical assistance. The new constitutional amendment would clarify that, if the Feds ever drop their match below 90%, the South Dakota Constitution would no longer require us to continue Medicaid expansion.

To be clear, the proposed amendment does not eliminate Medicaid expansion.

If passed, South Dakota could keep Medicaid expansion in place, but it would allow the legislature to debate if South Dakota taxpayers can afford it if the federal match changes from the 90% those voters previously agreed to.

For example, if the feds cut their share to 70%, the state would have to allocate an extra $40 million a year, and South Dakotans would have to consider cuts to other programs to pay for that increase.

Several other states enacted Medicaid expansion with language like this, including Montana, Utah, Arizona, Illinois, Indiana, Arkansas, New Hampshire, Virginia, and North Carolina. In some cases, these states will automatically withdraw from Medicaid expansion if the feds drop their contribution below 90%. Our proposal would not do that. It is more like Iowa, Idaho, and New Mexico, which simply allow the legislature to consider other options if the feds cut funding.

We want to emphasize that this proposed amendment honors the will of the voters. The voters passed Medicaid expansion with the clear understanding that the federal government would pay 90% of the costs. In 2024, the voters supported us by improving the constitutional language to allow for a work requirement for able-bodied adults. With this proposal, we are once again asking the voters to clarify their intent: If the federal match rate for Medicaid drops below 90%, do they want the legislature to be able to consider the budgetary implications?